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Temporal trends in validated ischaemic stroke hospitalizations in the USA.

TitleTemporal trends in validated ischaemic stroke hospitalizations in the USA.
Publication TypeJournal Article
Year of Publication2019
AuthorsKoton S, Wruck L, Quibrera PMiguel, Gottesman RF, Agarwal SK, Jones SA, Wright JD, Shahar E, Coresh JJ
Secondary AuthorsRosamond WD
JournalInt J Epidemiol
Date Published2019 06 01
KeywordsAged, Brain Ischemia, Databases, Factual, Female, Hospitalization, Humans, Male, Middle Aged, Reproducibility of Results, Stroke, United States

BACKGROUND: Accurate assessment of the burden of stroke, a major cause of disability and death, is crucial. We aimed to estimate rates of validated ischaemic stroke hospitalizations in the USA during 1998-2011.

METHODS: We used the Atherosclerosis Risk in Communities (ARIC) study cohort's adjudicated stroke data for participants aged ≥55 years, to construct validation models for each International Classification of Diseases (ICD)-code group and patient covariates. These models were applied to the Nationwide Inpatient Sample (NIS) data to estimate the probability of validated ischaemic stroke for each eligible hospitalization. Rates and trends in NIS using ICD codes vs estimates of validated ischaemic stroke were compared.

RESULTS: After applying validation models, the estimated annual average rate of validated ischaemic stroke hospitalizations in the USA during 1998-2011 was 3.37 [95% confidence interval (CI): 3.31, 3.43) per 1000 person-years. Validated rates declined during 1998-2011 from 4.7/1000 to 2.9/1000; however, the decline was limited to 1998-2007, with no further decline subsequently through 2011. Validation models showed that the false-positive (∼23% of strokes) and false-negative rates of ICD-9-CM codes in primary position for ischaemic stroke approximately cancel. Therefore, estimates of ischaemic stroke hospitalizations did not substantially change after applying validation models.

CONCLUSIONS: Overall, ischaemic stroke hospitalization rates in the USA have declined during 1998-2007, but no further decline was observed from 2007 to 2011. Validated ischaemic stroke hospitalizations estimates were similar to published estimates of hospitalizations with ischaemic stroke ICD codes in primary position. Validation of national discharge data using prospective chart review data is important to estimate the accuracy of reported burden of stroke.

Alternate JournalInt J Epidemiol
PubMed ID30879069
PubMed Central IDPMC6659364
Grant ListHHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States